A new bipartisan committee’s working group will gather on Capitol Hill throughout the coming months to find ways to improve electronic health records, according to Senate health committee chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.).

The group will work to find five or six ways to “make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure,” Murray said in an announcement.

All members of the Senate health committee are invited to be a part of the working group. Staff meetings begin this week, with participation from health IT professionals, industry experts and government agencies.

The working group’s goals include the following:

Help providers improve quality of care and patient safety.

Facilitate interoperability between EHR vendors.

Empower patients to engage in their own care through access to their health data.

Protect privacy and security of health information.

The working group isn’t the only way Alexander and Murray are pushing for change when it comes to EHRs.

Most hospitals don’t have good ways of measuring the complex costs associated with an individual patient’s stay in the hospital. The VA is one surprising exception.

The success of health reform in the US depends on finding ways to control the growth of costs. Hospital care is expensive. And when patients have to be readmitted unexpectedly after discharge, it can really crank up spending.

As we strive to keep health care costs in line, reducing hospital readmissions is drawing a lot of attention. Reducing preventable readmissions could reduce health care spending and improve quality of care at the same time.

But very little research on readmission costs has been done. An exception is a study that found that one in five elderly Medicare patients is readmitted to the hospital within 30 days of being discharged, at an estimated cost of $17.4 billion in 2004.

Most hospitals don’t have good ways of measuring the complex costs associated with an individual patient’s stay in the hospital.

But there is, however, a hospital system that does a very good of job of tracking these costs: the Veterans Health Administration.

Veterans Affairs could provide a blueprint

The Veterans Health Administration (the VA) operates 119 acute care hospitals across the US, and has created an unparalleled comprehensive patient-cost accounting system, its Decision Support System (DSS).

The DSS works from the bottom up by summing the individual resources and costs each individual patients winds up needing during their hospital stay. Unlike most other hospital accounting systems, the VADSS also can separate costs that are fixed regardless of the volume of services provided, such as administrative overhead, from costs that vary with service volume, such as lab tests or imaging. All of this means that the VA can track patients’ costs with greater precision than most hospitals, and can more easily see the cost of readmissions.

There are other reasons why VA is a good setting for studying readmission costs. VA hospitals have a simpler set of incentives around readmitting patients. Under Medicare, hospitals face a trade-off between receiving payments for readmitting Medicare patients and avoiding payment penalties for not readmitting patients under the new ACA regulations.

But in the VA system, budgets are set annually, so there is no financial incentive to readmit patients. It will not increase the amount of money VA hospitals get. And physicians who work in VA hospitals are salaried VA employees. They do not gain financially when they readmit patients, so they have no incentive to provide unnecessary care.

How much money does preventing readmission save?

In a recent study, Theodore Stefos and I used 2011 Decision Support System data to examine the component of cost that varies with a readmission, to provide hospital managers with a more realistic estimate of how much they could save by reducing readmissions.

We found that managers could expect to save $2,140 for the average 30-day readmission prevented. For heart attack, heart failure, and pneumonia patients, expected readmission cost estimates were higher: $3,432, $2,488 and $2,278 respectively.

We also found that patients’ risk of illness was the main driver of expected readmission cost. This is an important finding for managers. Even though this is a factor they cannot control, they can expect that patients with a greater risk of illness might be at greater risk after controlling for other factors such as age. Men also were much more likely to be readmitted than women, as were lower income and unmarried vets. Understanding this information can help hospital managers better predict which patients are at risk for readmission, and to take steps to address this proactively.

While the VA has some processes of care that differ from other health care systems, its experience has important lessons for private sector hospitals, especially for those that treat a high share of chronically ill or low-income patients.

Why it is important to know what readmissions cost

Today hospitals are under increasing pressure to curb readmissions. For instance in 2013 Centers for Medicare & Medicaid Services (CMS) started to financially penalize hospitals for 30-day readmissions that exceed national averages for heart attack, heart failure and pneumonia. As of October 2014, chronic obstructive pulmonary disorder and elective knee and hip replacements are also being targeted and the penalty has increased up to 3% of the total Medicare reimbursement to the hospital.

Hospital managers would like to know what actual cost savings are when a readmission is avoided, so they can understand how readmissions affect their overall budgets.

MINNEAPOLIS — Jerome Pate, a homeless alcoholic, went to the emergency room when he was cold. He went when he needed a safe place to sleep. He went when he was hungry, or drunk, or suicidal.

“I’d go sometimes just to have a place to be,” he said.

He made 17 emergency room visits in just four months last year, a costly spree that landed him in the middle of an experiment to reinvent health care for the hardest-to-help patients here in Hennepin County.

More than 11 million Americans have joined the Medicaid rolls since the major provisions of the Affordable Care Act went into effect, and health officials are searching for ways to contain the costs of caring for them. Some of the most expensive patients have medical conditions that are costly no matter what. But a significant share of them — so-called super utilizers like Mr. Pate — rack up costs for avoidable reasons. Many are afflicted with some combination of poverty, homelessness, mental illness, addiction and past trauma.

Jerome Pate, a homeless alcoholic, made 17 emergency room visits in just four months last year, which landed him in the middle of Hennepin County’s experiment to better manage cases like his.Credit Angela Jimenez for The New York Times

They raise a new question for the health care system: What is its role in tackling problems of poverty? And will addressing those problems save money?

“We had this forehead-smacking realization that poverty has all of these expensive consequences in health care,” said Ross Owen, a county health official who helps run the experiment here. “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.”

“This is a holy grail in research right now,” said John Vu, a vice president at Kaiser Permanente, one of the largest insurers and care providers in the country. Kaiser has about two dozen projects in the United States, including in Denver, where medical teams screen for food insecurity.

Here in Hennepin, a fist-shaped county that encompasses Minneapolis, the pilot program is focused on about 10,000 people — mostly men, all poor, some homeless — who were covered when the state expanded Medicaid under the Affordable Care Act. It is paid for with state and federal Medicaid dollars and run by the county government and the safety-net hospital.

The aim is to fix patients’ problems before they become expensive medical issues, so the county put its social services department to work. Its workers help people get phones and mailboxes, and take care of unpaid utility bills that otherwise could lead, for example, to insulin spoiling in nonfunctioning refrigerators. The project has even invested in a place where inebriated patients can sober up instead of going to the emergency room.

The idea — to eliminate avoidable hospital use — went against years of economic habit. Hospitals make money by charging per visit and procedure, and fewer of both would dent revenues. So the state offered a carrot: The hospital, Hennepin County Medical Center, a series of gray buildings and glass walkways, would be paid a fixed amount per patient and it would get to keep the money even if patients did not show up, or used less medical care than was paid for. The pilot program would work on caring for patients in places outside the hospital that are cheaper.

The arrangement, a stark departure from past practice, is increasingly common, part of the changes wrought by the health care law. The federal government has made similar deals with health systems for Medicare patients.

Some early experiments have found little or no savings in the short term. But in Hennepin County, medical costs have fallen on average by 11 percent per year since 2012 when the pilot program began, enough to keep it going and the hospital involved. Some of the biggest cost reductions were among the more than 250 patients who were placed into permanent housing.

The future of such efforts is uncertain. For programs that work to actually take root, more states and insurance companies may need to expand what they are willing to cover, for example, housing assistance, said Allison Hamblin, an expert at the Center for Health Care Strategies.

And it is unclear if private health systems — which have little experience in taking care of social needs and still make most of their money per procedure — will be as enthusiastic as Hennepin County Medical Center.

“We often hear comments that amount to ‘Are you asking me to fight the war on poverty?’ ” said Kelly W. Hall, a senior vice president at Health Leads, a nonprofit organization that helps medical teams connect patients to social services. “But doing nothing is ‘don’t ask, don’t tell’ when it comes to the realities of patients’ lives. People aren’t comfortable with that either.”

Mr. Pate, 51, came to the Hennepin County hospital’s emergency room last summer complaining of chest pains and thoughts of suicide. His arrival flickered on the screen of a social worker, Cerenity Petracek. She marched out to the emergency room to meet him.

“I was thinking ‘Who is this person?’ ” Mr. Pate recalled, noting that she was not wearing a doctor’s coat. “How’s she supposed to help me?”

She spent over an hour with him and learned that he was homeless and addicted to cocaine and alcohol. She called around, found a treatment program that would accept him, helped him fill out the paperwork and then put him in a car to make sure he got there. A doctor later diagnosed a major heart blockage.

For the hardest-to-reach patients, there are outreach workers in the community. Such positions have been rare in health care because neither Medicare nor Medicaid would cover them. But the Affordable Care Act has opened up new ways to do so.

On a frigid morning in February, Prugh Jose, 42, a soft-spoken homeless man suffering from alcoholism and anxiety, called T.J. Redig, an outreach worker who was part of his medical team. Mr. Redig — who wears stylish wool hats and writes novels in his spare time — has a friendly, easygoing manner that earned Mr. Jose’s trust.

Mr. Jose needed to get to the clinic for an appointment about his seizures (from a head injury on a construction job) but had forgotten the time for it. He had not eaten since the previous morning. His ex-wife offers him a couch when he can contribute food, but he had none, and spent the night outside.

“It was cold last night, Prugh,” said Mr. Redig, 29, steering his dented green Pontiac onto the Interstate. He has even picked up Mr. Jose from the highway overpass where he panhandles.

“Yeah, really cold,” Mr. Jose said. “I went to see my buddies and stuff, but no one opened up.”

By the time Mr. Jose got to the clinic, he had missed his appointment. But he was gaining things that could help prevent an emergency later. A community health worker gave him a bag of food: frozen chicken, cereal and canned fruit. The receptionist handed him apple juice, which he used to take anti-seizure pills.

“Better,” he said, after a long swig.

A version of this article appears in print on March 23, 2015, on page A13 of the New York edition with the headline: Ounce of Prevention: Health Care Systems Try to Cut Costs by Aiding Poor. Order Reprints|Today’s Paper|Subscribe

A flood of new health care IT companies has been pouring into the U.S. health care market. The cause of this torrent: the recognition that as market and regulatory forces alter incentives in health care, IT companies will play a powerful role in combating the overemployment and declining productivity that has plagued this industry and in helping providers improve the quality of care.

The dam broke in September 2007, when Athenahealth went public, the price of its shares jumping by 97% on the first day. Since then, the company’s value has risen to $5 billion. Athenahealth proved to entrepreneurs, software engineers, and investors that the health care sector is fertile ground for creating large technology-services companies that use a subscription-based business model to offer software as a service (SaaS).

Despite its size and growth rate, the health care sector was long considered an impenetrable, or at least an unattractive, target for IT innovation — the entrepreneurial equivalent of Siberia. Athenahealth broke the ice by proving that it could sell SaaS efficiently to small physician businesses, get doctors to accept off-premises software, and achieve the ratios of customer-acquisition costs to long-term value that other sectors already enjoy.

As Athenahealth accomplished its goals, several larger forces have dramatically widened the scope of opportunity in the sector:
•The Great Recession led to a loss of 8.8 million U.S. jobs and big declines in demand throughout the economy (including health care services) — yet health care employment grew by 7.2%. That reality increased awareness that a decline in labor productivity was driving much of the excessive spending in health care.
•The American Recovery and Reinvestment Act of 2009 included the Health Information Technology for Economic and Clinical Health (HITECH) Act, a $25.9 billion program to give doctors and hospitals incentives to adopt electronic health records. EHR adoption has now grown to nearly 80% of office-based physicians and 60% of hospitals, fueling many successful software start-ups, such as ZocDoc, Health Catalyst, and Practice Fusion.
•The Affordable Care Act (ACA) requires that an enormous amount of data on cost and quality be made freely available. In addition, digital health applications, mobile phones, and wearable sensors, as well as breakthroughs in genomics, are creating truly big data sets in health care. These data contribute to greater market efficiency, more consumer-oriented products and services, and clinical care that is evidence-based and personalized.
•The ACA has led to a proliferation of risk-based (rather than fee-for-service) payment models. For example, providers in accountable care organizations are rewarded for generating annual savings, and providers who use bundled payments get a fixed budget for an end-to-end course of treatment. Effectively responding to these changing economic incentives will increase reliance on software that helps providers manage population risk, understand costs and trends, and engage patients.

These macro-level developments set the stage for other SaaS companies to follow Athenahealth’s lead in enormously improving labor productivity and quality of care.

Within the next decade, software tools will eliminate thousands, perhaps millions, of jobs in hospitals, insurance companies, insurance brokerages, and human resources departments. Not the jobs of people who actually provide care — but those of administrative middlemen, whose dead weight contributes to economic loss. Here are five examples:

1.Digital insurance markets, combined with ACA-enacted regulatory changes such as guaranteed issue and community rating, make it possible to price and sell health plans to anyone immediately. These developments will decimate the armies of brokers who act as intermediaries between customers and insurance services.

2.Price transparency, digital insurance products, and tools such as reference pricing make it possible to generate an exact price and instantly collect payment for a health care service. As a result, revenue cycle managers in hospitals and claims adjudicators in insurance companies will be displaced.

3.The inevitable shift to the cloud will render obsolete the costly, insecure data centers that most doctors and hospitals are now building, staffing, and running.

4.Adopting self-serve mobile applications will eliminate the forms, faxes, and excess staffing at many call centers, thereby improving satisfaction for everyone in the process.

5.Centralized clearinghouses that share information across organizations and state lines will eventually replace the byzantine, paper-based process of credentialing doctors, tracking continuing medical education, and keeping licenses up-to-date. That means smaller staffs in hospitals’ medical affairs divisions, health plans, medical boards, and state and local health departments.

Given that wages account for 56% of all health care spending, improvements in labor productivity could generate enormous value. Simply reducing administrative costs could yield an estimated $250 billion in savings per year.

As compelling as the prospective labor efficiencies are, the benefits of SaaS extend beyond direct labor costs. Easier access to data on physician quality, specialization, and adherence to evidence-based care will better match patients with doctors who provide high-quality, efficient services, thereby averting health complications for their patients. Moreover, software can help bring relevant clinical guidelines and personalized risk scores to patients and clinicians as they improve care plans, engage in shared decision making, and avoid duplicative services. Such efficiencies will, in turn, enhance how patients perceive and experience the care they receive. SaaS companies can trumpet all of these advantages, not just the employment savings they yield.

To seize on the new opportunities in the health care sector, SaaS companies can take these steps:
•Attack economic inefficiencies in order to generate immediate, tangible customer return on investment. Witness how Castlight Health’s transparency tools are generating annual savings for employers and employees. And be clear about the source of the ROI, given that in most cases the revenue comes from another health care stakeholder who may be able to undermine the business.
•Focus on building in network effects so that improvements made by one user enhance the product’s value for current and future users, just as Athenahealth does when it rapidly disseminates changes in payment rules at one provider to all other providers. Most SaaS businesses in health care IT cannot protect their intellectual property; so it is important to continually augment the value of the product to achieve scale.
•Use software-enabled service models, rather than pure SaaS. For example, Grand Rounds’ software not only recommends an expert doctor for a patient but also collects, organizes, digitizes, and summarizes the patient’s records — and then books the appointment for the patient. In effect, the software makes it easier for patients to adhere to high-quality, cost-effective care, thereby enhancing the overall ROI for the product.

It took Athenahealth a decade, from 1997 to 2007, to go public on the strength of its SaaS model. It took Castlight Health only six years, from 2008 to 2014, to do the same. Now an array of highly valued healthcare SaaS companies, each worth more than $100 million, is emerging. They include Zenefits, Grand Rounds, Doctor on Demand, Omada Health, Health Catalyst, Doximity, and Evolent Health. Indeed, Zenefits is one of the fastest-growing SaaS companies ever, regardless of industry, surpassing $500 million in enterprise value in its first year.

The success of SaaS companies in health care is thanks, in part, to an influx of leaders from other sectors. They bring with them teams of technical talent that deliver consumer and enterprise software faster, better, and more cheaply than many legacy health care IT companies can do. Witness ZocDoc, founded by first-time entrepreneurs from McKinsey; Grand Rounds, founded by Owen Tripp, who cofounded Reputation.com; Zenefits, founded by Parker Conrad, who cofounded SigFig; and Doctor on Demand, founded by Adam Jackson, who cofounded Driverside (just to name a few). This type of cross-pollination is an essential ingredient of innovative change.

The barriers between health care IT companies and IT in other industries are clearly coming down, and we expect the number of sector disruptions and billion-dollar companies to swell. As each innovation wave generates more data, disruption-cycle times will shorten, thereby forcing all players in the health care ecosystem to address inefficiency as they compete on quality and value creation. Those who fail to act will be washed away by the tide that lifts all other boats to greater productivity.

Interoperability and Meaningful Use efforts need to be aligned with other healthcare regulatory and industry initiatives, according to the eHealth Initiative, which on Thursday unveiled its 2020 roadmap for transforming health IT.

The roadmap, which eHealth Initiative CEO Jennfier Covich Bordenick calls “a framework for discussion about core technology issues,” includes priorities for three areas: business and clinical motivators, interoperability and data access and use. In particular, she says, the private sector’s role must grow in order for health IT to move forward.

“We are heading into a world where healthcare data needs to be exchanged, shared and analyzed, not simply pushed from place to place,” Bordenick says in the document. “Similarly, we are developing a 2020 roadmap that requires sharing, analysis and above all, collaboration.”

Compared to the Office of the National Coordinator for Health IT’s interoperability roadmap, which will be available for public comment in January, the eHealth Initiative calls its plan “much broader,” but acknowledges that there is overlap between the two efforts to ensure synchronicity.

The roadmap specifically calls for an extension of time between Stages 2 and 3 of the Meaningful Use program, and also says that compliance with ICD-10 by next October is mandatory. The adoption of standards and open architecture also is encouraged for interoperability to evolve, as is the adoption of “approaches reflecting cross-industry IT trends” such as REST and FHIR.

Additionally, the roadmap says that Meaningful Use, despite its importance, is not a “sufficient lever” to ensure interoperability throughout healthcare.

A survey published in September from Premier and the eHealth Initiative concluded that poor interoperability is a significant barrier for accountable care organization success.

“We envision a high-performing healthcare system centered around the patient, where all those engaged in patient care are linked together in a secure and interoperable environment,” the roadmap says.

The roadmap also looks to kick-start conversations about how to solve several privacy and security challenges in healthcare today, including data security, appropriate data sharing, granular data control, data provenance and data matching.

Why do so many seemingly great technologies fail to penetrate the health care system?

I hope the following five answers shed some light on the realities of technology adoption in health care.

1. Many new technologies don’t address the real problem

Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it.

This technique often teaches entrepreneurs a tough lesson: Technology is worth nothing if it doesn’t solve an important problem or improve lives.

Alan Cooper, considered by many to be the father of modern user experience design (UXD), said the ideal approach is “goal directed.”

Meaning, innovators should start with the goals of the end-user. The solutions come next. When the order is reversed, the results usually disappoint.

As an example, the health care world recently has become enthralled with wearable devices. Many of these devices help solve the problem of what gift to give a loved one during the holidays. But few of these devices solve major health problems.

These wristbands, sensors, headsets and even “smart clothes” can obtain and transmit huge amounts of data on anything from heart rhythms to blood pressure. But there’s little evidence those wearing them overcome abnormal heart rhythms or elevated blood pressures better than those who don’t.

Besides, physicians don’t want all that data anyway. They find it overwhelming, redundant and unlikely to make a clinical difference.

Physicians would love a tool that truly helps patients better manage their diet, exercise and stress levels. Many applications available today claim to modify behavior through alerts, reminders and real-time feedback, but few have demonstrated measurable success.

Entrepreneurs hoping to make a positive impact on our health should focus on helping patients avoid chronic diseases and manage health problems when they arise. And they would be wise to do this using technology that already exists while developing solutions that are easy to use and inexpensive to buy.

Apps using new, complex or expensive technologies will face an uphill battle for adoption.

2. No one wants to pay for new technologies

Creating an innovative tool or app that can help doctors and patients isn’t enough. These products must also be monetized.

In health care, that proves difficult.

Patients, physicians, hospitals and insurance companies long for the benefits and value of new technology. However, each thinks someone else should pay for it.

Further, entrepreneurs must understand the financial difficulties inherent in health care’s current fee-for-service payment model. Doctors and hospitals will be slow to embrace any technology that lowers costs or reduce patient visits. Why? Because today’s payment model financially rewards doctors and hospitals for the volume and cost of services they provide — not the quality of outcomes they achieve.

Until our payment model moves from fee-for-service to “pay-for-value,” some of the most effective technological solutions will be hard to sell.

3. Physicians are reluctant to show patients their medical information

Prior to the modern electronic health record (EHR), common wisdom was that doctors owned the medical information contained in a patient’s chart.

It made sense at the time. With only one copy of the medical record on hand, the safest place for it was the chart room located in the back of the doctor’s office.

Many doctors believed it was necessary to keep it out of the hands of patients, worrying the information could be harmful if read.

Much has changed in the era of information technology and consumerism. More and more, patients object to the paternalism of the past – asserting their right to access to their own health records.

But now there’s new medical record problem arising. As computers and keyboards replace charts and pens in exam rooms across the country, technology is now the physical barrier between patients and physicians.

But computers don’t have to create distance.

Some doctors are flipping their computers around and using the health data on screen to educate patients. This transparency ensures the information is accurate. It invites patients to participate more closely in their own treatment plans.

Still, today’s exam-room computers are clunky. Physicians would relish a more user-friendly tablet, capable of rapid data entry and mobility. And patients want access to their health data beyond the doctor’s office. Entrepreneurs who can address both of these needs will find an eager market.

4. Technology slows down many physicians

For the average physician, entering data into an EHR takes longer than keeping a paper record.

The problem isn’t just the time it takes to type but also the structured format of the data entry. It simply takes more time when the application prevents physicians from skipping steps or leaving out clinical details.

Frustrating as it may be for doctors, the added information reduces the risks of medical error, avoids redundant testing, and facilitates easier access to test results. But the benefits to the patient are clear, even when the technology adds time for the physician.

Just think, an EHR can prompt surgeons to ask patients about drug allergies as part of their medical history. Using this information, an EHR app can trigger an alert should the doctor accidentally try to order an antibiotic the patient is allergic to.

Physicians like to assume they’d never make such a mistake. Science proves otherwise. Some estimate the rate of drug errors by doctors has jumped 50 percent in recent years. Another study found 1 in 5 medications used by seniors are prescribed inappropriately.

Entrepreneurs can help physicians reduce the time needed for data entry by developing software applications that include macros and smart lists. Apps with alerts can help reduce medical errors.

But, of course, getting doctors to embrace these more effective approaches will be the next big challenge.

The doctor is likely to talk about the importance of the human touch or about how subjective the “art of medicine” is.

Yes, these are important factors in medicine. But providing personalized care in the future will require much more than that.

With the advent of gene sequencing and the exponential growth of medical information, physicians won’t be able to meet the unique medical requirements of individual patients without advanced IT systems.

As medical knowledge advances, the perceived rift between “high tech” and “high touch” is becoming a relic of the past.

Telling a patient he has cancer requires time, compassion and well-honed interpersonal skills. This is the traditional art of medicine. But figuring out the exact cancer treatment — given dozens of alternatives, the patient’s unique genetics and the many sub-types of each cancer – is more a matter of technology and science. Increasingly, treatment possibilities exceed the human mind.

In addition, when doctors lament modern medical practice becoming impersonal, they fail to understand how most people prefer to manage their lives.

In today’s era of consumerism, if you ask patients what they mean by personalized medical care, they’ll talk about being able to decide how, when and where they obtain information and treatment — just like they do when they travel or buy retail products and services.

Today’s busy people want to receive care through technologically enabled alternatives like video visits and secure email, rather than through the traditional office visit. And they’re frustrated by a health care system that refuses to accommodate them.

There’s a waiting market for entrepreneurs who can help people receive care virtually, without having to miss work or school — particularly if the solutions are less expensive.

To meet these preferences, entrepreneurs need to look further than at the hundreds of millions of smartphones resting in the hands or pockets of Americans today.

Overcoming these barriers

Across history, it often has been the next generation that figures out how best to use new technology. Health care may be no different.

But if hungry entrepreneurs don’t want to wait 10 or 15 years for the demographics to change, they would be smart to provide solutions that use currently available technology to solve patient’s problems in the simplest and least expensive ways.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on Forbes.com.

In a post two weeks ago, we were critical of some aspects of the JASON Task Force’s (JTF) Final Report on healthcare interoperability. Two members of the JTF reached out to us in order to clarify the intent of the report as it relates to EHRs and the use of a “public” API to help make healthcare applications more interoperable. During a long conversation, we had a chance to discuss the issues in detail. Following that discussion we took some time to reconsider our opinions.

We now have to agree that the JTF itself was not EHR vendor dominated and have corrected the previous post. The Task Force was comprised of a wide range of stakeholders including several providers. Unfortunately, however, the testimony the JTF received was overwhelmingly from HIT vendors, consultants, or their proxies. We doubt this was intentional, but simply the vendor community having a more vested interest in influencing the JTF. But it does lead us to the conclusion that it is incumbent upon the JTF to proactively solicit provider testimony before policymakers act on the recommendations of the JTF report.

Despite our long conversation with these members of the JTF, we still have a difference of opinion on one key issue: The central importance of the EHR with regards to public APIs and interoperability.

The original JASON Report points squarely at EHRs as the source of interoperability ills. It also called for EHRs to adopt the public API. By our count, the JTF Final Report uses three different ways to describe where the public API should sit: a “Data Sharing Network”, “CEHRT”, or “clinical and financial systems.” In our follow-up discussion, JTF representatives maintained that the intent to include EHRs is clear and that the task force struggled on this issue of how broad their mandate was.

The JTF decided to cast a broader net than just the JASON Report’s initial focus on EHRs. But they did not clarify an already complicated issue, nor did they unequivocally single out EHRs as where the need for a public API should begin. We think that their intention to include EHRs is sincere but maintain the position that the JTF should explicitly recommend that EHRs expose services and data with the public API. Without such clarity, the fuzzy language used in the JTF report could end up being adopted in future rule-making or legislation, creating the potential for uncertain outcomes.

Our Thesis:
Good, bad, or otherwise, the EHR is the dominant application supporting clinical workflows and the source of most patient healthcare data.

Every provider we have ever talked to says that improved patient care and more effective care coordination would be possible with better access to other providers’ EHRs. On the other hand, we have not talked to many providers who say that better patient care and better care coordination would be possible if only there was better access to other providers’ financial systems. The majority of providers have never heard of a Data Sharing Network (and no, we do not believe Direct can fill this bill) so the public API is pretty much dead in the water there as well – though most any HIE/CNM vendor worth their salt would welcome a public API.

So let’s be perfectly clear in the JTF report – if we want EHRs to adopt a public API, then let’s just say so rather than beating around the bush. To do otherwise sends the wrong message to the market – that EHRs are somehow not central to the interoperability problem.